What is Emotional Dysregulation/BPD psychotherapy?

Emotions are essential for our survival and physical and emotional wellbeing. We experience a range of different emotions in our daily lives, ranging from ones such as love, joy, excitement and gratitude, to emotions such as sadness, anger, shame and frustration. Being able to feel these emotions is very important as both pleasant and unpleasant emotions can be useful in guiding our decision-making. Some people have the ability to feel the full range of emotions very intensely. These people, are often seen as sensitive, very empathetic, or even gifted, as the capacity to feel emotions deeply may be a source of creativity or it may even help them to understand others better.

Most of us struggle with our emotions from time to time. However, some people have regular and long-lasting difficulties with their emotions, as they find it difficult to regulate their emotions. For some of these people, the intensity of their emotions can be severe enough to interfere with their daily lives and relationships. For those people, their emotions can feel overwhelming and emotional responses can change very quickly and often last longer than feels comfortable. This can have negative effects on their relationships with others and themselves (leading to low self-esteem), and can affect their work and their physical health. For some people, the distress and suffering can be too much and in order to cope they may self-harm, abuse substances, or threaten to or even attempt suicide, or engage in other impulsive behaviours that put their safety and well-being in danger.

Common Symptoms and Behaviours of Emotional DysregulatioN

Some of the most common symptoms that people with emotional dysregulation tend to experience are:• They have very intense and overwhelming emotions that tend to last from a few hours to a few days;• They tend to experience mood swings (for example, feeling happy in the morning but very unhappy in the afternoon); • They feel very worried about people abandoning them, which often results in them doing anything to stop this from happening;• They have a weak sense of who they are, which often changes depending on who they are with;• They find it very difficult to make and keep stable relationships;• They tend to experience intense anger, which if often projected onto others, while they also struggle to control their behaviour, which at times can manifest as them being physically violent (in particular towards their partners);• They tend to act impulsively and do things that could harm themselves (for example, binge eating, taking drugs or alcohol use, or being sexually promiscuous);• They often feel suicidal or engage in self-harm in order to cope with their emotional pain;• They tend to tend to get easily stressed and are more prone to feeling overwhelmed during stressful times;• They often feel or become numb and can experience memory gaps; • They have a pervasive sense of disconnection from others and themselves, which often results in feelings of loneliness and emptiness that at times can manifest as feeling that an intense lack of meaning or purpose in life.

Causes of Emotional Dysregulation

The causes of emotional dysregulation can be many and usually include a combination of traumatic live events and genetic factors. Most people that suffer from emotional dysregulation have in one way or another experienced s with their emotions since their childhood. These could be a result of neglect, or trauma due to physical, sexual or emotional abuse. It is often the case that emotional dysregulation is the result of relational or attachment trauma experienced during childhood for people who grew up in family environments that were dismissive or invalidating, or where they were completely discouraged from displaying any negative emotions at all.

Some people with emotional dysregulation may have been mislabelled or misdiagnosed with Borderline Personality Disorder (BPD). I want to say at this point that I do not subscribe to this pathologising and stigmatising view that labels emotionally intense people as being mentally ill or ‘disordered’. The whole term BPD gives rise to a huge misunderstanding about the very essence of emotionally dysregulated people’s personality, the ‘borderline’ label implies an inadequate or half personality, which is not the case. I have therefore adopted the more fitting description of emotional dysregulation, as I feel it better explains the heightened emotional sensitivity and reactivity associated with being an emotionally intense person. Additionally, as implied by the term emotional dysregulation, emotionally intense people can learn and practice how to regulate their emotions, as has been the case for many people I have worked so far.

Specialised Emotional Dysregulation and BPD Psychotherapy

My approach to working with emotional dysregulation and BPD symptoms is based on a combination of Person-Centred Therapy, Attachment-Based Psychotherapy, Somatic Psychotherapy and Dialectical Behaviour Therapy (DBT). DBT is an evidence-based and research proven therapy that is widely considered one of the most effective and successful forms of psychotherapy in the treatment of emotional dysregulation. It is a combination of Cognitive Behavioural Therapy and Mindfulness practices that facilitates change at the behavioural level in your everyday life through practicing and learning specific skills that will enable you to increase behaviours that are helpful and life-affirming, while at the same time learning how to reduce risky and problematic behaviours that compromise the quality of your life. During our work together, we will collaboratively design a program or practices that will enable you to learn skills, such as:

Skills & Strengths Training; learning practices to regain control of your life

• Emotion Regulation: Where you will learn how to understand and name your emotions, change unwanted emotions, manage extreme and often destructive emotions, such as anger, reduce vulnerability, fragility and impulsivity, reduce dissociation and emotional numbness, and learn and practice responding instead of reacting. • Distress Tolerance & Resilience: Where you will learn how to defuse, accept and feel less overwhelmed by intense emotions, and learn self-soothing, grounding and centring skills that will allow you to become less affected in moments of heightened emotional arousal and crisis. • Self-Care & Self-Management Skills: Where you will learn about sleep hygiene, diet, exercise, yoga, meditation.• Mindfulness Practices: Where you will learn how to become present in the moment, to observe in an open and non-judgemental way the dialogue between your emotional and rational mind and make decisions based on your ‘wise’ or balanced mind. • Interpersonal Effectiveness: Where you will learn to describe, express, negotiate and assert your needs, validate and affirm others and their needs, be compassionate and gentle with others, cope with unavoidable conflict and develop self-respect. • Validation and Self-Validation (of thoughts, feelings, sensations and behaviours): Where you will learn skills, such as being present, reflecting accurately, articulating un-verbalised emotions or thoughts, normalisation of suffering (that is, validating, acknowledging and accepting yours or others experiences as valid and understandable based on what is going on for them currently within their lives), and radical genuineness (that is, seeing yourself and others not as fragile, incapable or mentally ill but as fundamentally sane and capable human beings). Validation is arguably one of the most important skills and strengths that you will cultivate, as practising and communicating acceptance and validation will empower you and strengthen your relationships with yourself and others, while at the same time, self-validation allows you to manage your emotions more effectively. • Self-Compassion, where you will learn practices that enhance compassion towards yourself, and you will also become more able to engage with yours the others’ suffering with more courage and wisdom and to become more able to lessen or alleviate suffering.

Somatic Psychotherapy; working with mind, body and spirit to enhance recovery and healing

Research studies have shown that somatic practices and holistic therapies can be extremely beneficial in assisting recovery from emotional dysregulation and BPD symptoms and for this reason we will employ a range of different practices such as mindfulness-based therapy, breathing training and yoga. Additionally, if there is an indication that the emotional deregulation is the result of trauma, we will also use various tools and methods from trauma-specific approaches, such as somatic experiencing, polyvagal theory, interpersonal neurobiology and affective neuroscience. As dissociation can also be one of the main symptoms in emotional dysregulation, we will also use specific techniques to reduce dissociative states and the emotional numbness or emptiness that can often manifest as a result of dissociation. Person-Centred and Attachment-Based Psychotherapy; A relationship that heals based on collaboration, empathy, radical genuineness and acceptance, warmth and safety In this healing journey, our therapeutic relationship will also be one of the most important elements that will contribute to the success of regulating your emotions and reclaiming your life. From the beginning of our work together I will endeavour to foster the conditions that will create a safe and trusting environment where you feel heard, understood, accepted and validated. Other characteristics of our relationship and my approach towards you will be: • Collaboration and shared responsibility: The initial phase of formulation and assessment will be based on building a shared understanding of the origins and nature your difficulties. You will be involved actively in the creation of your healing program, and there will be an ongoing discussion and negotiation in terms of the methods and strategies that we will be using. • Emotional validation of your emotions and unconditional acceptance of your inner experience: You will find me willing and able to resonate with your painful emotions and able to tolerate the intensity of them; even the most overwhelming and self-destructive ones. My acceptance of all your inner experiences may be transformative for you, as by experiencing and witnessing your intense emotions as tolerable within our relationship, you will hopefully gradually become able to self-soothe and finally to self-regulate your emotions. • Active hope and guidance: The healing journey can often be long, challenging and painful. You may at times lose hope and trust both in yourself and our work. In these moments, you will find me offering you unwavering emotional support, active guidance, advice and a temporary holding space (within our relationship) in order to help you to withstand the ‘emotional storm’ or crisis you may experience and restore faith and hope in your healing journey. At times of crisis, I may become more directive in offering guidance and advice. I may also become more directive if I asses that you did not have a containing parenting experience in your childhood, in which case I may work with you to help you develop safe boundaries both for yourself and those you interact with. However, I want you to rest assured that, just like a good parent, my aim is to help you cultivate your own strength and agency and not to foster dependency. This process is designed to help you internalise the faith and hope that I hold in your ability to heal yourself and recover.

I want to communicate to you that most people with emotion dysregulation and BPD traits are able to reduce their symptoms over time, and about half eventually become symptom-free and comfortably able to manage day-to-day life. Throughout the years, I have helped many people to regulate their emotions and to reclaim their lives. If you are an emotionally intense person, or someone that has been diagnosed with BPD, please do not suffer in silence. Do get in touch and I will be happy to assist you in healing yourself. I offer psychotherapy for BPD and Emotional Dysregulation in Edinburgh and online.

I look forward to helping you heal and flourish.

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The Life Academy - Edinburgh Counselling, Psychotherapy and Coaching Practice, offers Psychotherapy and Counselling in Edinburgh and online. Harris is an Edinburgh Counsellor, Psychologist, Psychotherapist and Philosophical Coach whom offers counselling and psychotherapy to individuals and couples.